Table 2:
Grade 4 Studies with very low level of evidence
| Study design | Previous treatment failure | No. of patients | Treatment regimen | Treatment adverse effects | Treatment outcome | Outcome from ACP grading |
|---|---|---|---|---|---|---|
| 1) Retrospective, case report. [Collier et al; Clin Exp Dermatol. 2017; doi:10.1111/ced.13238] | Doxycycline, rifampicin, clindamycin, IST, acitretin, CS, CsA. | • 26-year old man | • Systemic PDT with ultraviolet light (100–140 J/cm2) with 1mg/kg porfimer sodium. | • None | • FD in remission at 25 months followup. | Grade 4 |
| 2) Retrospective, case series. [Burillo-Martinez et al; J Am Acad Dermatol.2016; 74(4):e69–70.] | Oral and intralesional CS, antibiotics | • Total patients: 3 men
• Mean age: 30 years |
• PDT • Mean: 11 sessions over mean of 9 months. • Concurrent treatment with sulfamethoxazole-trimethoprim. |
• Pain and erythema in all patients. Worsening of condition in one patient. | • 2 patients had mild improvement after
PDT session but relapsed before next cycles. • 1 patient had worsening of FD during treatment and required oral CS. |
Grade 4 |
| 3) Retrospective, case report. [Elsayad et al; Strahlenther Onkol. 2015; 191(11):883–8] | Tetracycline, rifampicin, cefaclor, clarithromycin, linezolid, CS, CsA, IST. | • 45-year old man | • First course radiotherapy: 5 Gy in 5
fractions • Second course radiotherapy: 6 Gy in 5 fractions 5 months later. |
• Mild pain, erythema and transient increased scalp exudate. | • FD and associated symptoms significantly improved especially pain and pruritus at 12 months follow-up. | Grade 4 |
| 4) Prospective, single center, case series. [Miguel-Gomez et al; J Am Acad Dermatol. 2015;72(6):1085–7] | Doxycycline, IST, rifampicin. | • Total patients: 10 • 5 were men. |
• PDT with MAL (Metvix) 160mg/g cream
at 4 week interval. • Area treated with a red light at 630nm with a total light dose of 37 J/cm2. • 2 patients received concurrent doxycycline and intralesional CS. |
• 6 (60%) patients experienced local reaction post-PDT and pain. | • FD in remission for 9 (90%) patients.
Duration of remission ranged from 2 to 36 months (mean 9.9 months).
• No. of pts and (no. sessions): • 1(13), 1(9), 1(6), 1(5), 3(4), 1(3). |
Grade 4 |
| 5) Retrospective, case report. [Ismail et al; J Dermatolog Treat 2015; 26(5):471–2] | Clindamycin, rifampicin | • 27-year old man | • IVIG 2g/kg first month then reduced
to 1g/kg from second to fourth month. • Concurrent flucloxacillin up to 3 infusions. |
None | • FD in remission at 6 months followup. | Grade 4 |
| 6) Retrospective, singlecenter, case series. [Kreutzer et al; J Dtsch Dermatol Ges 2014;12(1):74–6] | Clindamycin, rifampicin, dapsone, methotrexate, oral CS, IST. | • Total patients: 2 women
• Age (58 and 50 years) |
• Adalimumab 40mg every 2 weeks. | None | • FD in remission after 2–3 months of treatment. Long term follow-up unavailable. | Grade 4 |
| 7) Case report. [Meesters et al; J Dermatolog Treat 2014;25(2):167–8] | Tetracycline, Erythromycin, Doxycycline, Flucloxacillin, IST. | 34-year old man | • Long-pulsed Nd:YAG 1064-nm
laser. • Started at 30J/cm2 for 50ms. Dose increased to 50J/cm2 with reduced pulse duration to 30ms. • Total of 9 treatments, 8–12 week interval. |
• Pain and mild crusting but relived with topical lidocaine ointment and oral tramadol 50mg during treatment. | • FD in remission at 1.5 years followup. | Grade 4 |
| 8) Retrospective, case report. [Mihaljevic et al; J Dtsch Dermatol Ges 2012; 10(8):589–90] | IST, oral CS, oral antibiotics, dapsone and zinc. | 45-year old man | • Infliximab 5mg/kg every 46 weeks. | None | • FD in remission after 3 infusions until 12 months follow-up. | Grade 4 |
| 9) Retrospective, case report. [Castano-Suarez et al; Photodermatol Photoimmunol Photomed. 2012; 28(2):102–4] | Topical CS, IST, Dapsone | 32-year old woman | • PDT with MAL (Metvix)
• 630 nm delivered at 37J/cm2; 3 cycles over 8 week period. Each cycle involved 2 treatments with 2 weeks apart. |
Mild itching | • FD in remission at 12 months followup after last treatment. | Grade 4 |
| 10) Retrospective, case series.[Bastida et al;
Int J Dermatol. 2012;51(2):216–20] |
Acitretin, dapsone, oral and topical CS, antibiotics | • Total patients: 4 • 3 were
women • Age (23–40 years) |
• Tacrolimus (0.1%) ointment twice
daily. • One patient had combination treatment with doxycycline 100mg daily. |
None | • FD in remission at follow-up (range 2
months - 2.5 years). • Relapse occurred shortly after treatment discontinued. |
Grade 4 |
| 11) Retrospective, case report. [Parlette et al; Dermatol Surg. 2004;30(8):1152–4] | Dicloxacillin, tetralysal, doxycycline, minocycline, Levofloxacin, ILT, IST. One course of Radiation. | 26-year old man | • Nd:YAG laser at 28 J/cm2, 3msec pulse
duration, a 12mm spot, and dynamic cryogen spray cooling set at a
50-msec spray and a 20-msec delay. • Patient received 8 treatments at 4- to 6-week intervals. |
Significant pain during treatment | • FD in remission at 6 months followup. | Grade 4 |
| 12) Retrospective, case report. [Gemmeke et al;Acta Dermatovenerol Alp Pannonica Adriat.. 2006; 15(4):184–186.] | Prednisolone and ampicillin | 27-year old man | • Isotretinoin 30mg daily, Oral clindamycin 300mg/d for 6 weeks, Prednisolone 20mg daily tapered within 3 weeks. | None | • At 3 weeks, marked reduction in
inflammation and partial regrowth in non-scarred scalp
areas. • At 6-month follow-up, no disease progression was noted. |
Grade 4 |
| 13) Retrospective, case report. [Kaur et al; J of Dermatol. 2002;29(7):180–181.] | Multiple short courses of low dose
corticosteroids and antibiotics |
42-year old male | • Rifampicin 600 mg PO once daily
• Topical 2% Mupirocin ointment |
None |
• At 2 weeks, pain and folliculitis disappeared, and no new pustules formed. • Alopecia did not extend but scarring persisted. • Complete resolution of FD at 6-month follow up. |
Grade 4 |
| 14) Retrospective, case report. [Kunte et al; J Am Acad Dermatol. 1998;39(5 Pt2): 891–3] | Flucloxacillin, IST, topical superpotent CS. | 27-year old man | • Dapsone 100mg daily | None | • FD in remission for 18 months. | Grade 4 |
Abbreviations: FD: Folliculitis decalvans, PDT: Photodynamic therapy, CS: Corticosteroids, IVIG: Intravenous immunoglobulin, MAL: Methyl aminolevulinate, CsA:Cyclosporin, IST: Isotretinoin, ILT: Intralesional triamcinolone, Nd:YAG: neodymium:yttrium aluminum garnet